A California resident is one who is in California for other than a temporary or transitory purpose; or Domiciled in California, but outside California for a temporary or transitory purpose. (ftb.ca.gov/ page 7).

Service Area – “Service area” is the geographic area approved by the Centers for Medicare & Medicaid Services (CMS) within which an eligible individual may enroll in a certain plan, and in the case of network plans, where a network must be available to provide services. (Freedom Blue EOC Page 157)

Members Who Change Residence
MA organizations may offer (or continue to offer) extended “visitor” or “traveler” programs to members of coordinated care plans who have been out of the service area for up to 12 months. The MA organizations that offer such programs do not have to disenroll members in these extended programs who remain out of the service area for more than 6 months but less than 12 months. …Organizations offering MA-PFFS plans may allow continued enrollment of individuals absent from the plan service area for up to 12 months,…50.2.1

MA organizations offering plans without these programs must disenroll members who have been out of the service area for more than 6 months.

2 comments on “Residency – CA, USA – Which State?”

The “U.S.” includes the 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, the
Northern Mariana Islands, and American Samoa Medicare & You Page 57

I like to document everything I say. So, I know that a Medi-Gap policy simply pays based on what Medicare Pays, let’s find that in the policy.Blue Shield “N.” Table of contents is on page 6. Page 12 is benefits

1. Blue Shield will pay the following:

a) Coverage of Part A Medicare Eligible Expenses for hospitalization to the extent not covered by Medicare from the 61st day through the 90th day in any Medicare Benefit Period;

b) Coverage of Part A Medicare Eligible Expenses incurred for hospitalization to the extent not covered by Medicare for each Medicare lifetime inpatient reserve day used. Each Medicare beneficiary is given sixty (60) lifetime reserve days which begin from the 91st day and after;

c) Upon exhaustion of the Medicare hospital inpatient coverage including the sixty (60) lifetime reserve days, coverage for the Medicare Part A Eligible Expenses for hospitalization will be paid at the appropriate standard of payment which has been approved by Medicare, subject to a lifetime maximum benefit of an additional 365 days (except that psychiatric care in a psychiatric hospital participating in the Medicare program is limited to 190 days during the Subscriber’s lifetime);

d) Room and board charges shall be no more than the charge for a semi-private accommodation in the Hospital of confinement, unless confinement in a subacute skilled nursing facility or private room is certified as medically necessary by an attending Physician.

Thus, Medi-Gap pays based on Medicare. Medicare covers Puerto Rico, so will Medi-Gap. Let me see if I can find another expert who agrees with me.

Medicare.Gov agrees: If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share.

You can buy a Medigap policy from any insurance company that’s licensed in your state to sell one.

I know I’ve been told that once you have a Medi-Gap plan you can keep it anywhere in the USA. I don’t see any residence requirements in the policy, nor agent guide, which does state you must live in the service area to get a Medicare Advantage plan. Thus, one can keep their Medi-Gap plan, anywhere, anytime.

You can check with Medicare.gov to check what PDP Rx plans are available. Please verify your zip code.

In the Blue Shield confidential agent guide, PDP Rx can only be sold in the service area – State. Thus, you would need to get coverage for Puerto Rico from a local agent or Medicare.Gov. You can do that at open enrollment or when you move. That would be a special enrollment period.

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This web site is owned and maintained by Steve Shorr Insurance, which is solely responsible for its content. This site is not maintained by or affiliated with Covered California, and Covered California bears no responsibility for its content. The e-mail addresses and telephone numbers that appear throughout this site belong to Steve Shorr Insurance, and cannot be used to contact Covered California, directly, unless specifically stated. Steve Shorr is not a medical doctor, a tax accountant, or an attorney. The contents of this site are for informational purposes only. For more details, please read the site's Disclaimer, Visitor Agreement, and Privacy Statement.